西田 修

BACKGROUND: Since the concept of post-intensive care syndrome (PICS) was proposed, numerous studies have assessed patients and their family members. However, a wide range of assessment timings has been employed across previous studies. This study aimed to clarify how assessment timings have been implemented in existing PICS research through a scoping review, and to explore expert opinions on optimal assessment timing via an online survey. METHODS: We conducted a scoping review of studies assessing PICS-related outcomes, including physical, cognitive, and psychological impairments, as well as PICS in family members. Studies were retrieved from MEDLINE, CENTRAL, and CINAHL, and screened by two independent pairs of reviewers. Eligible studies were published between January 2014 and December 2022. Studies lacking a clear description of assessment timing were excluded. We analyzed the reference point used to determine assessment schedules, the assessment time points, and their frequency. Additionally, an online questionnaire was administered to 23 members of the Japanese Society of Intensive Care Medicine PICS committee and working group members to collect expert opinions on these three aspects for clinical research. RESULTS: A total of 657 studies were included. In prior studies, hospital discharge was the most commonly used reference point for determining assessment schedule (240 studies, 40%). However, ICU discharge was identified by experts as the ideal reference point (16 votes, 47%). The most frequently used assessment time points were 3 months (262, 23%), 6 months (212, 19%), and 12 months (206, 18%) post-discharge. Experts most commonly selected the period between 6 and 12 months as the optimal time point for assessment. While single assessments were most common in previous studies (337, 51%), experts considered three assessments to be ideal (12, 44%). CONCLUSIONS: This study revealed notable discrepancies between the assessment timing reported in previous studies and the opinions of experts regarding optimal timing. Standardization of assessment timing in PICS research is warranted to enhance methodological consistency and comparability.

Introduction This study aimed to compare autophagic activity in peripheral blood mononuclear cells (PBMCs) between intensive care unit-acquired weakness (ICU-AW) and non-ICU-AW patients, and to evaluate phase-specific differences and their associations with immune and inflammatory profiles. Methods This single-center, cross-sectional observational study included 42 patients who required mechanical ventilation for more than 48 hours between April 2020 and March 2022. PBMCs were collected within 48 hours of ICU admission (early phase) and on day 7 (late phase). Autophagic activity, assessed by mean fluorescence intensity (MFI), was evaluated via flow cytometry using DAPGreen (Dojindo, Kumamoto, Japan). ICU-AW was diagnosed based on a Medical Research Council sum score of less than 48 points. Results Among the 42 patients, 14 (33.3%) developed ICU-AW. PBMCs from ICU-AW patients demonstrated significantly lower autophagic activity in the early phase compared to non-ICU-AW patients (non-ICU-AW vs. ICU-AW patients: MFI of granulocytes, 30.9 (22.6, 51.7) vs. 20.4 (18.0, 22.6), p < 0.001; and lymphocytes, 94.6 (64.9, 123.0) vs. 65.2 (58.0, 77.5), p = 0.011). In contrast, excessive autophagic activity was observed in some ICU-AW cases during the late phase (MFI of granulocytes, 21.0 (17.9, 22.9) vs. 33.8 (22.9, 56.0), p < 0.001; and lymphocytes, 67.5 (54.4, 93.5) vs. 106.2 (64.6, 124.5), p = 0.012). The proportion of monocytes was also significantly reduced in the ICU-AW group. These findings suggest that impaired early-phase autophagy may contribute to ICU-AW pathogenesis, whereas delayed overactivation could be associated with persistent inflammation and impaired muscle recovery. Conclusion Autophagic activity in PBMCs exhibited temporal alterations in patients with ICU-AW. These findings suggest a potential association between dysregulated autophagy and muscle dysfunction in critically ill patients. Further research is needed to explore whether modulation of autophagy could inform future preventive strategies.

We report a case in which excessive negative pressure may have been applied to the proximal side hole of a drainage cannula during venovenous extracorporeal membrane oxygenation (V-V ECMO), resulting in abnormal stenosis of the drainage cannula. V-V ECMO was introduced in a 71-year-old male patient who was transferred from another hospital for severe respiratory failure associated with varicella pneumonia and acute respiratory distress syndrome. Drainage was performed using a PCKC-V™ 24Fr (MERA, Japan) cannula via the right femoral vein with the tip of the cannula near the level of the diaphragm under fluoroscopy. Reinfusion was performed via the right internal jugular vein. Due to poor systemic oxygenation, the drainage cannula was withdrawn caudally and refixed to reduce the effect of recirculation. Two days later, drainage pressure dropped rapidly, and frequent ECMO flow interruption occurred due to poor drainage. An abdominal X-ray revealed abnormal stenosis of the proximal side hole site of the drainage cannula. We diagnosed that the drainage cannula was damaged, and it was replaced with another, namely a Medtronic Bio-Medicus™ 25 Fr (GETINGE, Sweden) cannula. However, the removed drainage cannula was not damaged, suggesting that the cannula was temporarily stenosed by momentary excessive negative pressure. In a multi-stage drainage cannula, the main drainage site is the proximal side hole, with little negative pressure applied at the apical foramen in a mock experimental ex vivo drainage test in a water tank. Hence, improvement of a multi-stage drainage cannula is recommended, such as adequate reinforcement of the side hole site with a wire.

Abstract Background Sepsis 3 definitions have shifted the focus from nonspecific inflammation to sepsis as an organ dysfunction caused by a dysregulated host response to infection. Neutrophils have become therapeutic targets because of their intimate but complex involvement in sepsis. We conducted ex vivo and animal experiments to apply a granulocyte and monocyte adsorption column, which is clinically used for inflammatory bowel disease, in sepsis. In this study, the biocompatibility was evaluated in sepsis-like hypercytokinemia. Methods Six female outbred pigs were anesthetized. Extracorporeal direct hemoperfusion (DHP) with an Adacolumn or a sham column was initiated after lipopolysaccharide (LPS) administration. The DHP was performed for 2 h at a blood flow rate (QB) of 30 or 60 mL/min. Blood samples were collected before and during the DHP (30, 60, 90, and 120 min). The percentage change in white blood cell count, platelet count, and cytokine concentration was compared between the Adacolumn and sham columns. Results The percentage change in white blood cells were 96 (95–98)% and 106 (101–108)% in the Adacolumn and sham groups, respectively, at QB = 60 mL/min (p &lt; 0.01). The percentage change in platelets were 95 (90–96)% and 97 (93–99)% in the in the Adacolumn and sham groups, respectively, at QB = 60 mL/min (not significant; n.s.). At QB = 60 mL/min, the percentage change in tumor necrosis factor-α, interleukin (IL)-6, and IL-10 were 92 (81–106)%, 95 (93–102)%, and 98 (95–100)%, respectively, for the Adacolumn and 100 (95–102)%, 98 (87–104)%, and 97 (93–99)%, respectively, for the sham column. The percentage change in white blood cell counts, platelet counts, and all cytokines at QB = 30 and 60 mL/min showed similar trends. Conclusion The biocompatibility of the Adacolumn was evaluated using a porcine LPS-induced inflammation model. No decrease in platelet counts or significant cytokine production was observed, suggesting that the Adacolumn could be safely used in patients with sepsis with QB = 30–60 mL/min for 2 h. However, production of mediators other than cytokines remains unknown and requires further investigation.

Post-intensive care syndrome comprises physical, cognitive, and mental impairments in patients treated in an intensive care unit (ICU). It occurs either during the ICU stay or following ICU discharge and is related to the patients' long-term prognosis. The same concept also applies to pediatric patients, and it can greatly affect the mental status of family members. In the 10 years since post-intensive care syndrome was first proposed, research has greatly expanded. Here, we summarize the recent evidence on post-intensive care syndrome regarding its pathophysiology, epidemiology, assessment, risk factors, prevention, and treatments. We highlight new topics, future directions, and strategies to overcome post-intensive care syndrome among people treated in an ICU. Clinical and basic research are still needed to elucidate the mechanistic insights and to discover therapeutic targets and new interventions for post-intensive care syndrome.